Phase 2 Proof-of-Concept Study of the Safety and Efficacy of Alfimeprase to Rapidly Open Arteries and Restore Brain Function Following a Stroke
- Registration Number
- NCT00499902
- Lead Sponsor
- ARCA Biopharma, Inc.
- Brief Summary
The purpose of this study is to identify a safe and effective bolus dose of intra-arterial/intra-thrombus alfimeprase in acute ischemic stroke (AIS) 3 to 9 hours from symptom onset.
- Detailed Description
Currently approved drug therapy for AIS is limited by the need to treat within 3 hours of symptom onset. Alfimeprase acts to degrade fibrin directly and is inactivated locally by circulating alpha-2 macroglobulin. This study will determine whether treatment with alfimeprase facilitates rapid restoration of arterial blood flow with avoidance of symptomatic hemorrhagic conversion in subjects with AIS within 3 to 9 hours of symptom onset.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 7
- Clinical diagnosis of AIS defined as the sudden onset of an acute focal neurological deficit presumed to be due to cerebral ischemia
- Arterial occlusion of the carotid T or a M1, M2, or M1-M2 branch of the middle cerebral artery (MCA) as documented by CT angiography or magnetic resonance angiography
- Arteriographically confirmed occlusion of the carotid T or a M1, M2, or M1-M2 branch of the MCA
- The subject (or legally acceptable representative) must give written informed consent
- Age 18 years to 85 years
- Onset of symptoms of AIS (i.e., last known well time) within 3-9 hours
- Baseline NIHSS of 4 to 25
- Available for follow-up assessments at 30 and 90 days
- Contraindication to systemic anticoagulation including any history of prior intracranial hemorrhage
- Uncontrolled hypertension at study entry as defined by systolic blood pressure greater than 180 mmHg or diastolic blood pressure greater than or equal to 100 mmHg on repeated measures prior to study entry despite the use of IV antihypertensive agents
- Expectation based on timing of presentation that alfimeprase administration will not be able to be completed by 9 hours after stroke onset
- Inability to initiate alfimeprase within 120 minutes of the qualifying imaging scan
- Coma
- Rapidly improving neurological symptoms at the time of screening
- Brain CT or MRI evidence of intracranial bleeding of any age
- High clinical suspicion for subarachnoid hemorrhage despite a negative baseline CT or MRI
- CT evidence of an acute and/or evolving hypodensity greater than 1/3 of the MCA territory in the vascular territory to be treated or Alberta Stroke Program Early CT Score (ASPECTS) of less than or equal to 5
- MRI diffusion weighted imaging lesion greater than 1/3 of the MCA territory in the vascular distribution to be treated
- Carotid artery and/or intracranial artery stenosis that precludes safe passage of a microcatheter to treat the primary AOL
- Life expectancy of less than 6 months
- History of significant acute or chronic kidney disease, including known nephrotic syndrome, that would preclude safe contrast angiography
- Known allergy to contrast agents
- History of immune deficiency
- History of heparin-induced thrombocytopenia
- Participation in any study of an investigational device, medication, biologic, or other agent within 30 days prior to enrollment (Stage I)/randomization (Stage II)
- Any stroke, myocardial infarction, or use of thrombolytic therapy (including investigational thrombolytic therapy) within 3 months prior to enrollment (Stage I)/randomization (Stage II)
- Past participation in any alfimeprase clinical trial
- Pregnant, lactating, or actively menstruating women and women of child-bearing potential who are not using adequate contraceptive precautions
- Current use of oral anticoagulants or an international normalized ratio (INR) greater than 1.4
- Any non-atherosclerotic arteriopathy
- Any prior neurologic event that would obscure the radiographic or clinical evaluation of the new index neurological deficits
- Subjects with known renal insufficiency defined as a serum creatinine >2 mg/dL (>180 mmoL/L)
- Subjects with known clinically significant hepatic disease defined as transaminase values > 3x upper limit of normal
- Subjects with any malignant neoplasm diagnosed within five years prior to screening, with the exception of basal cell carcinoma of the skin and fully resected squamous cell carcinoma of the skin
- Subjects with a platelet count less than 100,000/mm3
- Subjects with a baseline serum glucose level less than 50 mg/dL or greater than 300 mg/dL
- Subjects receiving any dose of a heparinoid or a non-prophylactic intensity dose of a low molecular weight heparin within the 24-hour period prior to study drug administration
- Any other subject feature that in the opinion of the investigator should preclude study participation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description 2 stages alfimeprase This is a two-stage study. The first stage is in a three-tier dose escalation format, followed by a second stage during which subjects will be randomized in an equal proportion to up to 3 qualifying dose arms.
- Primary Outcome Measures
Name Time Method Symptomatic intracerebral hemorrhage (ICH) defined as a greater than or equal to 4-point increase in NIHSS compared to baseline at the time of CT evidence of ICH within 24 hours of study drug administration. Recanalization of primary arterial occlusive lesion (AOL) using the Thrombolysis in Myocardial Infarction (TIMI) classification; a score of II or III will be considered success.
- Secondary Outcome Measures
Name Time Method Relative hypotension requiring treatment (i.e. volume expanders and/or vasopressors) New cardiac events (e.g., cardiac ischemia, congestive heart failure, and dysrhythmia) Relative hypotension not requiring treatment Major bleeding events (TIMI definition) Hemorrhagic transformation: hemorrhagic infarction (Type 1 and 2), parenchymal hematoma formation (Type 1 and 2) Intracerebral hemorrhage outside of the stroke territory New AIS AEs/SAEs/All cause mortality Changes in chemistry, hematology, coagulation, and alpha-2-macroglobulin parameters based on central laboratory measurements Anti-alfimeprase antibody detection based on central laboratory measurements Recanalization of the primary AOL Global reperfusion of the primary AOL distal vascular bed defined by the Thrombolysis in Cerebral Infarction (TICI) score Neurological benefit as assessed by individual and combined analysis of NIHSS, mRS, and BI
Trial Locations
- Locations (21)
University of Calgary, Foothills Medical Centre
🇨🇦Calgary, Alberta, Canada
Vancouver General Hospital
🇨🇦Vancouver, British Columbia, Canada
Montreal Neurological Institute
🇨🇦Montreal, Quebec, Canada
Northwestern Medical Center
🇺🇸Chicago, Illinois, United States
UCLA Medical Center
🇺🇸Los Angeles, California, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Columbia Presbyterian Medical Center
🇺🇸New York, New York, United States
Albany Medical Center Hospital
🇺🇸Albany, New York, United States
Trilium Health Center
🇨🇦Mississauga, Ontario, Canada
Michigan State University, Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Kalieda Health, MFH
🇺🇸Buffalo, New York, United States
University Health Network Toronto
🇨🇦Toronto, Ontario, Canada
University of Kansas School of Medicine, Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
University of Iowa Hospital
🇺🇸Iowa City, Iowa, United States
Ruan Neurology & Clinical Research Center
🇺🇸Des Moines, Iowa, United States
Norton Hospital
🇺🇸Louisville, Kentucky, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Oregon Stroke Center
🇺🇸Portland, Oregon, United States
University of Pittsburg Medical Center
🇺🇸Pittsburg, Pennsylvania, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
St. Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States